Questions | PHA (Pain Health Assessment) descriptive labels |
---|---|
Q1 | Ethnicity |
Q2 | Race |
Q3 A – Q | Symptoms |
Q4 A – O | Syndromes and Diagnoses |
Q5 A – B | Worst and Least Pain Today |
Q6 A – G | Pain interfering (past 24 h) with activity, mood,walking, work, relationships, sleep, and enjoyment of life |
Q7 | Estimate of health |
Q8 A – B | Health limiting moderate activity, strenuous activity during typical day |
Q9 A – B | Health (past 4 weeks) limiting accomplishments or work |
Q10 A – B | Emotional problems (past 4 weeks) limiting accomplishments or work |
Q11 | Pain (past 4Â weeks) interfering with work |
Q12 A – C | Feelings (past 4 weeks); calm and peaceful, lot of energy, downhearted and depressed |
Q13 | Physical or emotional health (past 4Â weeks) interfering with social activities |
Q14 | Health compared to one year ago |
Q15 A – C | Worst pain, average pain, pain right now |
Q16 A – P | Activities of daily living |
Q17 A | Physical activity makes me hurt more |
Q17 B – D | Preconceptions; activity make me feel better, safe for me to be active, I should do normal work |
Q18 A - K | Feelings (past 4Â weeks). Pep, nervous, down in dumps, worn out, happy, tired, anxious, worry, angry, depressed, memory problems |
Q19 A – F | Pain getting in the way of; enjoying social activities, doing social activities, family relationships, friend relationships, pleasure with family, ability to plan |
Q20 A – D | Perception of control; life, handling problems, control of pain, coping with stress |
Q21 A – D | Time devoted to; visiting friends, partaking in groups, enjoying hobbies, activities outside the house |
Q22 A – D | Limitations (past 4 weeks), time on work or activities, accomplishments, performance |
Q23 | Initial pain before treatment |
Q24 | Average daily pain at this point in treatment |
Q25 | Relief received from treatments and medications |
Q26 A - G | Improvement in; activity, mood, walking, work, relationships, sleep, enjoyment of life |
Q27 A - K | Rating of clinical experience; time, courtesy, confidence, quality, administration, confidence of recommendations |
Q28 A - M | Questions regarding employment status and disability |
Q29 A - G | Specific questions regarding disability support |
Q30 | Marital status |
Q31 | Persons in household |
Q32 | Education |
Q33 | Smoking habits |
Q34 | Alcohol use |
Q35 | History of substance abuse |
Q36 | Family history of substance abuse |
Q37 | Preadolescent sexual abuse |
Q38 | Who completed PHA |
Q39 | How was PHA completed |